Bakhareva L. The diagnostic meaning of clinical and paraclinical peculiarities of atherosclerotic occlusive stenotic pathologies of internal carotid arteries for choosing the treatment tactics.

There were examined 132 patients with atherosclerotic stenosis of the internal carotid artery (ICA) with different clinical displays. 132 carotid endarterectomies were performed. The thorough neuralgic inspection, ultrasonic dopplerography, transcranial dopplerography with functional tests, the duplex scanning of extracrenial arteries, morphological investigation of the removed arteries segments were carried out in all the patients. In 51 cases out of 132 so called hemodinamically significant (more than 70 percent) stenosis of ICA were discovered, out of them 66 per cent were in asymptomatic patients. Hemodinamically insignificant stenosis were discovered in the other 57 cases, 72% of them in symptomatic patients. There were discovered the ultrasonic criteria of evaluating brain bloodflow of patients with pathology of extracrenial segment of carotid arteries. By the duplex scanning data there were registered 50 cases of heterogeneous athrosclerotic plaques connected with high risk of embolagenic complications in brain vessels, 81% of which were discovered in patients with transitory ischemic attack and remaining phenomenon of complete cerebral thrombosis stroke. In 43 cases there were discovered echo-dense plaques, 80% of which in asymptomatic patients with discircularatory encephalopathy. The results of ultrasonic and morphological examinations of plaques coincided in 87% of cases. Thus clinical displays don't depend on increasing the degree of internal carotid artery stenosis, but there's direct dependence of clinic stenosis lesions ICA on the morphostructure of plaques. Surgical treatment is performed to the patients with moderate (50-70%) stenosis of ICA with soft and heterogeneous plaques. Surgical treatment is not performed to the patients with strong and moderate neurological deficit after complete cerebral thrombosis stroke with hemodynamically significant stenosis and dense plaques because of high (14,2%) share of deaths and the absence of treatment effect in postoperative period.